<p>Flertalet studier har påvisat ett samband mellan koncentrationen av partiklar ≤ 10µm i luftföroreningar och cardiovaskulär- och pulmonell morbiditet och mortalitet. Vid resektion, koagulering/bränning med diatermipenna under operationer alstras rök. Denna rök innehåller bland annat mutagena och carcinogena partiklar i inhalerbar storlek (partiklar ≤ 10µm).</p><p>Ett första syfte med denna studie var att kvantifiera den mängd ultra-fina partiklar (UFP) och partiklar ≤ 10µm som operationspersonal exponeras för i operationsrummet, vid användande av diatermi med mobilt rökutsug. Ett andra syfte var också att ta reda på om operations-personal exponeras olika mycket beroende på var i rummet de befinner sig, samt undersöka om partikelnivåerna skiljer sig på olika operationssalar. Partikelmätningar utfördes under 14 ortopediska operationer där diatermi med rökutsug använts.</p><p>Medelvärdena av UFP visar på relativt låga partikelkoncentrationer på höftprotes- och ryggoperationer, med mycket korta stunder av höga värden upp till ett maxvärde på 88 396pt/ml vid operationsområdet. Även partiklar i storleken 1-10µm låg inom låga nivåer och under gränsvärdena vid jämförelse med organisk damm. Resultaten i studien indikerar att personal som står vid operationssåret exponeras av högre partikelkoncentrationer av ultra-fina partiklar och partiklar 1-10µm än övrig personal, även vid användande av mobilt rökutsug. Vid jämförelse av partikelnivåer av ultra-fina partiklar på två olika operationssalar framkom det att på den sal med lägst antal luftväxlingar i operationsrummet, var partikelkoncentrationen signifikant högre.</p>

The overall aim of this thesis was to explore surgical nurses’ experiences of being confronted with patients’ existential issues when caring for patients with cancer, and to examine whether an educational intervention may support nurses in addressing existential needs when caring for patients with cancer. Previously recorded discussions from supervision sessions with eight healthcare professionals were analysed (I), written descriptions of critical incidents were collected from 10 nurses, and interviews with open questions were conducted (II). An educational intervention on existential issues was pilot tested and is presented in Studies III and IV. The intervention was the basis of a pilot study with the purpose of testing whether the whole design of the educational intervention, including measurements instruments, is appropriate. In Study III and IV interviews with 11 nurses were conducted and 42 nurses were included in the quantitative measurements of four questionnaires, which were distributed and collected. Data was analysed using qualitative secondary analysis (I), hermeneutical analysis (II), and mixed methods using qualitative content analysis and statistical analyses (III-IV). Results in all studies show that existential issues are part of caring at surgical wards. However, although the nurses were aware of them, they found it difficult to acknowledge these issues owing to for example insecurity (I-III), a strict medical focus (II) and/or lacking strategies (I-III) for communicating on these issues. Modest results from the pilot study are reported and suggest beneficial influences of a support in communication on existential issues (III). The results indicate that the educational intervention may enhance nurses’ understanding for the patient’s situation (IV), help them deal with own insecurity and powerlessness in communication (III), and increase the value of caring for severely ill and dying patients (III) in addition to reducing work-related stress (IV). An outcome of all the studies in this thesis was that surgical nurses consider it crucial to have time and opportunity to reflect on caring situations together with colleagues. In addition, descriptions in Studies III and IV show the value of relating reflection to a theory or philosophy in order for attitudes to be brought to awareness and for new strategies to be developed.

Syftet med denna studie var att beskriva personers erfarenheter av sina kost- och motionsvanor före respektive efter en kirurgisk behandling mot fetma. Vidare var syftet att beskriva om personerna ansåg att operationen påverkat deras psykiska och fysiska hälsa. Kirurgiska behandlingar mot fetma har ökat under de senaste åren och forskning visar att det är den metod som ger bäst effekt för att behålla en långvarig viktnedgång i jämförelse med diverse dieter och fysisk aktivitet. En kvalitativ metod med innehållsanalyser användes där fem kvinnor som genomgått en operation mot fetma intervjuades. Kategorier har skapats utifrån hur det har sett ut före och efter operationen när det gäller kost- och motionsvanor samt psykisk och fysisk hälsa. Resultatet visade att kostvanorna hos alla deltagare före operation var oregelbundna där det mesta av maten intogs på kvällarna. Motion utövades i regel inte alls av de flesta deltagarna. Efter operation har samtliga regelbundna kostvanor och äter små portioner. Motionsvanorna har förändrats i den mån att fler promenader utförs men i övrigt ingen ökad fysisk aktivitet. Den psykiska hälsan har förbättrats för de flesta genom bättre självförtroende och ökad livskvalitet. Även den fysiska hälsan har förbättrats då deltagarna upplever mer ork och färre besvär med bland annat värk och högt blodtryck. Slutsatserna från studien är att kost- och motionsvanor förändrats men endast i viss utsträckning, däremot har den fysiska och psykiska hälsan förändrats till det bättre. / The purpose of this study is to describe how people who have undergone surgical treatment for obesity experience their diet and exercise habits before and after surgery. Furthermore, it intends to describe if the participants believe that the operation affected their mental and physical health. Surgical treatments for obesity has become more popular in recent years and research shows that it is the method most effective for maintaining weight loss in comparison with various diets and physical activities. A qualitative method with content analysis was used and five women who had surgery for obesity participated. The results showed that the dietary habits of all participants before surgery was irregular and the participants all ate large meals in the evenings. Exercising in general did not exist among the participants. After surgery, all participants had a regular diet and ate smaller portions. Exercise habits have changed to the extent that all take more walks but otherwise they have not increased their physical activity. Mental health has improved for most through better self-esteem and quality of life. Physical health has improved and the participants feel more strength and fewer symptoms, such as pain and high blood pressure. The conclusion from this study is that diet and exercise habits have changed but only to a certain extent, however, the physical and mental health has changed for the better.

People who are homeless rely heavily on acute health care facilities to meet basic health care needs. Medical-surgical nurses play a fundamental role in the health care and health outcomes of patients who are homeless. According to the Institute of Medicine, health care providers’ bias and stereotyping contribute to health disparities among marginalized and vulnerable populations. Because attitudes are linked to clinical decision making and behaviors, revealing how nurses’ attitudes towards patients who are homeless develop and transform is paramount to improving health disparities of the homeless population. The purpose of this study was to explore nurses’ clinical experiences with patients who are homeless in order to discover how attitudes toward care of the homeless develop and transform. Interpretive phenomenology was used to describe and interpret the experiences of 11 medical-surgical nurses who cared for patients who were homeless and reported their attitudes toward this marginalized population had transformed. Nurses’ clinical experiences ranged from 3 to 40 years. Audiotaped semi-structured interviews were conducted. Data analysis was ongoing throughout data collection as delineated by Diekelmann and Allen (1989) and expanded by Minick (1992). Five themes were revealed through interpretation of the rich data. The themes were ‘Discovering homelessness,’ ‘Finding common ground,’ ‘Piecing it together,’ ‘A daily struggle,’ and ‘Relationships based on distrust.’ Nurses’ attitudes were in constant development and transformation. Nurses’ life and clinical experiences created opportunities for attitude transformations. Experiences associated with attitude transformation were identified. Nurses’ experiences revealed how nurses enter practice with an established attitude toward this marginalized population. As nurses came to realize that homelessness was no longer an abstract, intangible concept rather homelessness existed and was present in their day-to-day nursing practices their attitudes began to transform. Nurses sought common experiences with patients who were homeless to create a sense of connectedness in nurse-patient relationships. Nurses described a daily struggle of maintaining positive, non-judgmental attitudes. Nurses shared how early experiences of negative encounters with patients who were homeless created feelings of distrust thus altering nurse-patient relationships with future patients who were homeless. This study contributes to nursing knowledge by revealing how medical-surgical nurses’ attitudes develop and transform and how experiences are associated with attitude change. Recommendations for nursing practice, education, research are identified.

Objective: Evaluation of surgical quality ensures consistency of care and facilitates improvements in the quality of care delivered. Methods: An overview of surgical quality measurement is presented. A system for monitoring thoracic morbidity and mortality (TM&M) at the Ottawa Hospital is introduced and evaluated. Results of a needs assessment survey on the involvement in thoracic surgical research and quality improvement initiatives are presented. Results: Structure, process, and outcomes reflect different viewpoints on how to evaluate surgical quality. The feasibility of the TM&M system is evaluated using descriptive and univariate statistics, while its inter-rater reliability is assessed amongst the Canadian Association of Thoracic Surgeons. Conclusions: Outcomes have been fundamental in the evaluation of surgical quality. TM&M classification system advocates for a practice of continuous quality improvement and provides standardized and reliable feedback on surgical outcomes. Results of the needs assessment have built a strong foundation of knowledge on prospective ways to enhance the monitoring of surgical quality.

Surgery precipitates a hypercoagulable state and has been shown to increase the development of cancer metastases in animal models, however mechanism(s) responsible for this are largely unknown. We hypothesize that the prometastatic effect of surgery may be secondary to postoperative hypercoagulable state. Surgical stress was induced in mice by partial hepatectomy or nephrectomy, preceded by intravenous injection of CT26-LacZ or B16F10-LacZ cells to establish pulmonary metastases with or without perioperative anticoagulation and their lung tumor cell emboli (TCE) were quantified. Fibrinogen and platelets were fluorescently labeled prior to surgical stress to evaluate TCE-associated fibrin and platelet clots. Surgery significantly increased metastases while anticoagulation with five different agents attenuated this effect. Fibrin and platelet clots were associated with TCE significantly more frequently in surgically stressed mice. Surgery promotes the formation of fibrin and platelet clots around TCE and this appears to be the mechanism for the increase in metastases seen following surgery.

The thesis focuses on a model that seeks to address patient scheduling step of the surgical scheduling process to determine the number of surgeries to perform in a given day. Specifically, provided a master schedule that provides a cyclic breakdown of total OR availability into specific daily allocations to each surgical specialty, we look to provide a scheduling policy for all surgeries that minimizes a combination of the lead time between patient request and surgery date, overtime in the ORs and congestion in the wards. We cast the problem of generating optimal control strategies into the framework of Markov Decision Process (MDP). The Approximate Dynamic Programming (ADP) approach has been employed to solving the model which would otherwise be intractable due to the size of the state space. We assess performance of resulting policy and quality of the driven policy through simulation and we provide our policy insights and conclusions.

Background: No spine-specific educational tool has been developed using input from all relevant stakeholders, including patients. Purpose: The objective of this study was to determine the information needs of lumbar microdiscectomy patients. Methods: Qualitative methods with thematic analysis was used. Focus groups were conducted with: 1) preoperative microdiscectomy patients; 2) postoperative microdiscectomy patients; 3) spine surgeons; 4) spine fellows; 5) orthopaedic surgery residents; 6) anesthesiologists; 7) surgeons’ administrative assistants; and, 8) preoperative assessment team. Results: Major information needs were related to: anesthesia, surgical procedure details and postoperative course. Patients desire information on postoperative course much more than surgeons perceive. Desired attributes of information tools as well as patient factors that influence the extent of information shared by surgeons were determined. Information resources should be given to patients as soon as they are deemed surgical candidates. Conclusions: Microdiscectomy patients desire more information than currently provided to them – in particular postoperative-related information.

Background: No spine-specific educational tool has been developed using input from all relevant stakeholders, including patients. Purpose: The objective of this study was to determine the information needs of lumbar microdiscectomy patients. Methods: Qualitative methods with thematic analysis was used. Focus groups were conducted with: 1) preoperative microdiscectomy patients; 2) postoperative microdiscectomy patients; 3) spine surgeons; 4) spine fellows; 5) orthopaedic surgery residents; 6) anesthesiologists; 7) surgeons’ administrative assistants; and, 8) preoperative assessment team. Results: Major information needs were related to: anesthesia, surgical procedure details and postoperative course. Patients desire information on postoperative course much more than surgeons perceive. Desired attributes of information tools as well as patient factors that influence the extent of information shared by surgeons were determined. Information resources should be given to patients as soon as they are deemed surgical candidates. Conclusions: Microdiscectomy patients desire more information than currently provided to them – in particular postoperative-related information.

This study was devised to test the hypothesis, "Does a preoperative interview between the operating room nurse and the surgical patient effect the nurses' level of empathy toward the patient?" The theoretical and conceptual foundation was based on Carl Rogers' theory that a high level of empathy has a positive effect on therapy outcomes. Nursing research has also demonstrated the importance of empathetic understanding in order to equip the nurse to meet the patient's needs.Two hospitals which had not utilized preoperative interviews were selected, and nurses from one hospital participated in the experimental group which initiated preoperative visits while nurses from the other hospital participated in the control group which did not visit preoperatively. The changes in empathetic levels of the nurses were assessed using the Barrett-Lennard Relationship Helper Scale. Analysis of covariance was used to test the hypothesis which was accepted at .05 significance level.Ball State UniversityMuncie, IN 47306